Percutaneous drainage with or without interval appendectomy to treat periappendiceal abscess results in fewer complications

and shorter overall length of stay [132–134]. The use of interval appendectomy after percutaneous abscess drainage or non-operative management of perforated appendicitis is controversial (Recommendation 2 C). A survey using a postal questionnaire showed that 53% of surgeons performed routine interval appendectomy because they worried about recurrence [135]. However, the recurrence rate of appendicitis (10%-25%) and the complication rate of interval appendectomy (23%) are similar [135, 136]. It was evident PRT062607 clinical trial that the chances of missing malignancy are low and thorough investigation is better than interval appendectomy in detecting colonic cancer. These studies support the view that interval appendectomy is unnecessary in 75-90% cases. Acute diverticulitis Several learn more major medical organizations, such as The American Society of Colon and Rectal Surgeons, The Society for Surgery of the Alimentary Tract, The American College of Gastroenterology,

European Association of Endoscopic Surgeons, have proposed recommendations [137–141]. The practice parameters published by The American Society of Colon and Rectal Surgeons on 2006 are particularly useful [137]. The recommendations written here are generally consistent with them. Complicated diverticulitis is defined as acute diverticulitis accompanied by abscess, VE-821 clinical trial fistula, obstruction, or free intra-abdominal perforation. Approximately 25% of patients diagnosed with diverticulitis for the first time present with complicated diverticulitis.

Uncomplicated diverticulitis, accounting for 75% of cases, refers to diverticulitis without the complications noted above. Hinchey Classification is used to describe perforations of the colon due to diverticulitis [142]. The classification is I-IV: Hinchey stage I – localized abscess (para-colonic), Hinchey stage II – pelvic abscess, Hinchey stage III – purulent peritonitis (the presence of pus in the abdominal cavity), and Hinchey stage IV – fecal peritonitis. Non-operative treatment, with bowel rest and antibiotics, is suggested in patients with uncomplicated diverticulitis (Recommendation 1 C). Conservative treatment of acute uncomplicated diverticulitis is successful 3-mercaptopyruvate sulfurtransferase in 70 to 100 percent of patients [137]. Uncomplicated diverticulitis may be managed as an outpatient (dietary modification and oral antibiotics) for those without appreciable fever, excessive vomiting, or marked peritonitis, as long as there is the opportunity for follow-up. The patient should be able to take liquids and antibiotics by mouth. Hospitalization is indicated if the patient is unable to take liquids or has severe pain, or if symptoms fail to improve despite adequate outpatient therapy. Antibiotics should be selected to treat the most common bacteria found in the colon: gram-negative rods and anaerobic bacteria [143].